Provider Demographics
NPI:1730786328
Name:IDAHO ONE HEALTH NETWORK, LLC
Entity type:Organization
Organization Name:IDAHO ONE HEALTH NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DVM, MPVM
Authorized Official - Phone:360-961-9586
Mailing Address - Street 1:4455 S MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6917
Mailing Address - Country:US
Mailing Address - Phone:208-888-8442
Mailing Address - Fax:
Practice Address - Street 1:4455 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6917
Practice Address - Country:US
Practice Address - Phone:208-922-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
Yes291U00000XLaboratoriesClinical Medical Laboratory